HEALTH INFORMATION

Toilet Training

Topic Overview

When should I start toilet training my child?

Your child must be both physically and emotionally ready for
toilet training. Most children are ready to start when they are
between 22 and 30 months of age, but every child is different. Toilet
training usually becomes a long and frustrating process if you try to start it
before your child is ready.

Before children can use the toilet,
they must be able to control their bowel and bladder muscles. Some signs of
this control are having bowel movements around the same time each day, not
having bowel movements at night, and having a dry diaper after a nap or for at
least 2 hours at a time. Children must also be able to climb, talk, remove
clothing, and have mastered other basic motor skills before they can use the
toilet by themselves.

Most children are physically ready to
toilet train before they are emotionally ready. Your child must want to use the
toilet and be willing to cooperate with you. He or she may even talk about
being a "big boy" or "big girl" and wearing underpants rather than diapers.
Training generally does not go well if your child is in the stage where "no" is
his or her automatic response to every request.

How long does it take to toilet train?

A child is
considered toilet-trained when he or she knows that it is time to go to the
bathroom and is able to climb onto and use the toilet with little help. The average time it takes is 3 months. Girls usually are toilet-trained a little earlier than boys are.1

Your child will likely need help with wiping after a bowel movement until age 4
or 5. He or she may also need extra help in unfamiliar bathrooms, such as
public restrooms, until about age 5 or 6.

What if my child resists?

If your child resists
using the toilet, he or she probably isn't ready. Sometimes toilet training
disruptions or delays are caused by stress or major changes in routine. Also, a
child who is doing well with toilet training may suddenly have difficulty for
no obvious reason. This is a normal part of toilet training. It is best to
start or resume toilet training when your child is receptive to it and in a
stable environment.

Your child's toilet training experience
should be positive. If it becomes a struggle or a battle of wills, it is best
to ease up or stop for a while. Although you may be ready for toilet training,
your child may not be.

What Is Normal

It can be hard to know when to start toilet training. In general, a child must be both physically and
emotionally ready before
toilet training can be successful.

Children go through a toilet readiness
phase that won't be the same for every child. Watch for physical and emotional
signs that your child is ready to toilet train. Things going on in your family
affect your child during this phase. It is not advised to toilet train during a
time of family change, such as when there's a move, a new baby, or
divorce.

When your child is ready to toilet train, the learning
phase can begin. During this time, provide opportunities to toilet train and
encourage your child.

Physical readiness

A child is physically capable
of being toilet-trained when he or she develops muscle control over the bowel
and bladder. This rarely happens before 18 months of age.

Some
basic signs that your child has bowel and bladder control include the
following:

Bowel movements occur on a regular, somewhat
predictable schedule.

Bowel movements do not occur during the
night.

Diapers frequently are dry after waking from a nap or for at
least 2 hours at a time.

Facial expressions, grunting, or squatting
show an awareness that he or she is passing urine or stool.

Your child must also be able to climb and remove
clothing. And he or she must be able to talk enough to communicate with you
about the need to use the toilet.

Emotional readiness

Your child may be physically
ready to toilet train after 18 months of age. But emotional readiness may take
more time. Your child must want to use the toilet. And he or she must be
willing to cooperate with you during the toilet-training process. For example,
training typically does not go well if your child is in the stage where "no" is
his or her automatic response to every request.

Your child shows
emotional readiness for toilet training in several ways. He or she may:

Tell you when his or her diaper is dirty and
ask to have it changed.

Be eager to please and able to follow
simple directions.

Tell you that he or she wants to use the toilet
or wear underwear instead of diapers.

Like to be neat and tidy.
Many children go through a period where they like being clean and
organized.

Act interested when other family members use the
bathroom.

Be careful of getting too excited about your child's
readiness after he or she shows one or two of these signs. A child may be
excited about using the potty, only to lose interest very quickly.

Delays in toilet training

It is normal for your
child to be doing well with toilet training and to suddenly begin having
problems. For example, he or she may try to "hold it" for long periods or want
to wear diapers again. This does not mean your efforts have failed. But it does
mean that you need to ease up on the training for a little while.

Stress in the home can interfere with a child's toilet training. For
example, toilet-training setbacks can be related to the arrival of a new baby,
a move, a change in preschool or child care, family conflict, or illness or
death of a close family member.

A child's toilet habits may also
be affected if he or she gets an illness, especially one that has a long recovery time.

Sometimes your child will not
cooperate—for no reason that you can figure out.

Resist
pressure from friends or family to toilet train your child too early. Parents
often feel that their child should be trained by a specific age or to meet a
deadline, such as for a requirement to enroll in a particular day care. You and
your child are less likely to become frustrated and more likely to have a good experience with
toilet training if it is not forced. Staying positive and relaxed is an
important part of training your child.

Negative reactions
typically do not help. Children need frequent praise throughout the entire
process of toilet training.

Measuring success

You will know your child is
toilet-trained when he or she regularly anticipates the need to go to the
bathroom and with little help is able to climb onto and use the
type of toilet (potty) that you provide. This process takes time, from weeks to
months. Each child is different. But most children are successfully trained
around age 3 or shortly thereafter (girls are typically trained a few months
earlier than boys). Your child may still need help now and then, such as with
wiping, until age 4 or 5. He or she may also need help and reassurance when
using a toilet in an unfamiliar bathroom, such as in a public restroom, until
about age 5 or 6.

Most toilet-trained children sometimes wet or
soil their pants during the day, usually because they get distracted. For
example, your child may ignore the need to go to the bathroom because he or she
does not want to interrupt playtime. These accidents may occur until your child
is 5 years old. Stress can also cause a child to revert to wetting his or her
pants.

Most children sometimes wet the bed at night until about 12
months after they use the toilet during the day. Many 3-year-olds wet the bed
at night at least once a month. Nighttime bed-wetting may even occur
sporadically into school age.

Common Concerns

Pressure to toilet train your child

You may be
confused about
when to begin toilet training. This is not surprising, considering that most
people are bombarded with advice and expectations from relatives, friends, and
day care providers. You may also have personal reasons for wanting your child
toilet-trained, such as being pregnant and wanting to
avoid having two children in diapers at the same time. Balancing all of these
factors can be a challenge.

Your child's physical and emotional
readiness for toilet training is the most important aspect of the timing.
Although you can begin toilet training your child at an earlier-than-average
age, it usually takes longer. Also, both you and your child will likely become
frustrated if you try toilet training before he or she is physically and
emotionally ready.

Your child is not ready
to start toilet training if he or she shows any resistance. Typically, a child
objects by:

Standing next to the potty and then going on
the floor.

Screaming and crying when taken to the
potty.

Seeming comfortable and even happy about sitting in a soiled
diaper.

Saying, "No potty!"

Accidental wetting or soiling

Toilet-trained
children may have some accidents up until school age. A child who has an
accident during the day is often in the middle of playing and simply holds it
too long. Nighttime accidents may occur frequently within the first 12 months
after children learn how to use the toilet during the day. Many 3-year-olds
wet the bed at night at least once a month.

Playing with stool

The focus on toilet training
sometimes inspires children to play with their stools. This is normal behavior.
Remind your child that stool is not a toy and that it belongs in the toilet.
Reinforce this idea by helping your child to flush it down the toilet. Help
your child satisfy a natural need to feel textures by offering playtime with
molding material, such as clay or Play-Doh, or finger paints.

Touching the genitals

Sometimes toilet training
sparks curiosity about where urine and stool come from, prompting some children
to feel and touch their genital area. This is a normal part of how children
learn about their bodies. Don't shame or punish your child for this behavior.
You can explain the function of the genitals and suggest that they are personal
body parts to be looked at and explored in private.

At the 2-year visit, the
health professional will ask you about your child's progress in
toilet training. This is a good opportunity to discuss
any concerns you have about your child's readiness.

When to Call a Doctor

Call your doctor if you have
concerns about your child's readiness for or progress with
toilet training.

Most children use the
toilet during the day consistently and successfully around age 3. Call your
doctor if your child:

Does not use the toilet during the day by age
4.

Continues to soil his or her pants after age 5.

How to Help Your Child

There are many different strategies
and approaches to
toilet training. The methods that work best use
positive reinforcement and begin intensive training only when a child is
physically and emotionally ready. Introduce the basic concepts of toilet use
gradually and repetitively to your child. As your child gains the necessary
skills, he or she will show a sincere interest in using the toilet.

Get ready

Before you decide to start toilet
training, make sure the household environment is stable and that all family
members are prepared to help in the process. Trying to start potty training
soon after having another child, while remodeling your home, while having a
succession of household guests, right before going on vacation, or during a
time of relationship problems will likely not be as successful as during a calm
period when the family can focus on helping your young child reach this
important developmental milestone.

Talk with your child about
having a bowel movement and about urinating. Your child may be more comfortable
saying "poop" and "pee." It is fine to use these words, but use the proper
terms as well so that your child learns what they mean.

Start to talk
with your child about how to use the toilet. Explain how the toilet works and
how your child will be able to use it when he or she is ready. Be enthusiastic
and always speak positively about your child's using the potty. Talk about how
he or she will no longer need to wear diapers, will get to wear underpants that
are more comfortable, and can go just like a big boy or girl.

You
can also use books and DVDs to help prepare your child. Ask your doctor or a
librarian for more information.

Get set

Take your child with you to
select a potty that is sturdy and comfortable. Be
patient and give your child time to get used to and comfortable with it. Some
ways to do this are by:

Letting your child move a portable potty
into his or her room or other play area to get used to having it around.

Helping make the potty special by personalizing it, such as
painting it or writing your child's name on it.

Letting your child
sit on it and read a book or sit on it with his or her diaper on while having a
stool or urinating. You can say, "This is your special chair for you to go
pee-pee and poop in. Soon you will use it just like grownups use the
toilet."

Your child may want to join you when you use the toilet.
If you feel comfortable with an audience, allow him or her to join you. Talk
with your child about what you are doing.

Toilet training is
usually more successful if you are relaxed and patient with your child.

Do not try to begin toilet training before
your child is physically and emotionally ready. Trying to toilet train your
child before this time creates frustration for both of you.

Avoid
power struggles, which will only make toilet training more stressful and last
longer. All experiences and associations with toilet training should be
positive. Do not scold, punish, or embarrass your child for failing to use the
toilet.

Do not verbally or physically force your child to sit on
a potty. Allow your child to sit on the potty only for 5 minutes at a time
unless he or she is beginning to pass stool or urine.

Tell your
child that it is up to him or her to decide when to use the toilet.

Go!

Eventually, your child will show an interest
in using the toilet. When this happens, follow your child's lead and start the
process. General suggestions that can make this process go more smoothly are
to:

Dress your child in clothing that is easy for
him or her to remove. Clothes that have elastic waistbands or easy-to-open
fasteners (such as Velcro) work best. Pull-on diapers also work well during
toilet training. Bib overalls and one-piece outfits are hard for a child to
take off.

Help your child feel comfortable and safe on the toilet.
Assure your child that he or she will not fall in. Some children feel more
comfortable sitting backward, facing the toilet tank.

Teach your
boy how to urinate as he sits on the toilet. (Some boys may need to push down
on their penis so that the urine stream goes into the bowl and not over the
front of the toilet seat.) As he grows taller, he can learn to urinate from a
standing position. A small step stool may help him reach the toilet bowl and
improve his accuracy. A step stool also supports the feet and allows your child
to push his or her feet against the stool during a bowel movement.

Teach your child to wipe properly. Show him or her how to
remove toilet paper from the roll, wipe, and throw the used toilet paper in the
toilet. Instruct girls to wipe from front to back, which helps avoid infection
caused by getting stool near the
urethra or the
vagina. Many children need help to wipe effectively,
especially after a bowel movement, until about age 4 or 5. You may want to keep
diaper wipes near the toilet to help remove residue without chafing your
child's skin.

Help your child flush the toilet. Some children are
afraid of the sucking mechanism of the toilet. If your child has this
fear, it is fine for you to flush the toilet after he or she leaves the room.
Eventually, your child will be able to flush the toilet without a
problem.

What to think about

Praise and encourage your
child for success. You can say, "You are sitting on your potty just like mommy
(or daddy, or big sister)" or "You are trying really hard to poop (or pee) in
your potty." Reward your child for trying to use the toilet. You can use verbal
praise and fun activities, such as stickers or special playtime with
you.

Accidents happen. Do not scold or punish your child for
accidentally wetting or soiling his or her pants. Be matter-of-fact and
reassure your child that it's okay and that he or she will get better with
practice. Also, remind your child to use the toilet when he or she wakes up in
the morning.

If you and your child are not making progress with
toilet training, it's okay. It's probably not the right time. Put the
potty chair away until your child shows that he or she wants to try
again.

The most important things to remember for toilet training
are to wait until your child and family are ready and to make it a positive
experience. Be patient, and look forward to the days ahead of freedom from
diapers.

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